Thursday, July 14, 2011

No Immunity For Clinical Medical Faculty

A decision issued yesterday by the Ohio Supreme Court:

In a 7-0 decision announced today, the Supreme Court of Ohio ruled that a physician who serves as a volunteer “clinical faculty member” by allowing students at a state university medical school to observe his private practice is not entitled to personal immunity from malpractice liability under R.C. 9.86 as an employee or officer of the state.  The Court’s opinion, which reversed a ruling by the 10th District Court of Appeals, was authored by Justice Paul E. Pfeifer.

The Ohio Court of Claims Act, Section 9.86 of the Revised Code, generally immunizes “officers and employees” of the state from personal liability for injuries caused by the negligent performance of their job duties. Rather than seeking recovery from the individual who allegedly caused injury, the law authorizes persons harmed  by state employees’ acts or omissions to recover damages by filing suit against the state in the Court of Claims.

In this case, patient Larry Engel Jr. suffered injuries as a result of alleged malpractice by Dr. Marek Skoskiewicz during the performance of two vasectomy surgeries on Engel at the Henry County Hospital in Napoleon. Engel was a patient of Dr. Skoskiewicz’ private medical practice. The hospital is a private, non-profit facility that is not affiliated with the University of Toledo or any other state agency. The surgeries were observed by a third-year medical student at the University of Toledo College of Medicine (UTCM) who was “shadowing” Dr. Skoskiewicz at the time as part of a program in which private physicians across the state serve as volunteer “clinical faculty members” of the state’s six medical schools by allowing medical students to observe the day-to-day operation of their private medical practices.

Engel filed a malpractice lawsuit against Dr. Skoskiewicz in the Henry County Court of Common Pleas. While Engel’s suit against him remained pending, Dr. Skoskiewicz entered a motion to dismiss or postpone proceedings in the common pleas court. He argued that because he was being observed by a medical student at the time he operated on Engel, he was acting within his capacity as an appointed member of the UTCM faculty. Accordingly, the doctor claimed he was immune from personal liability for Engel’s injuries, and Engel must pursue recovery for his damages by suing UTCM in the Court of Claims. The common pleas court postponed further proceedings pending a ruling by the Court of Claims on whether or not the doctor qualified for personal immunity under R.C. 9.86.
In order to obtain such a ruling, Engel filed suit against UTCM in the Court of Claims. The Court of Claims concluded that Dr. Skoskiewicz had “performed the operations as a state employee” and that, therefore, he was entitled to personal immunity. Engle appealed. The 10th District Court of Appeals affirmed, based on its conclusion that Dr. Skoskiewicz “satisfies the definition of ‘officer or employee’ in R.C. 109.36(A)(1)(a).” The Supreme Court accepted Engel’s discretionary appeal.

Writing for a unanimous Court in today’s decision, Justice Pfeifer agreed with UTCM’s arguments that Skoskiewicz was not acting as a state employee at the time he operated on Engel because there was no contract of employment between the doctor and the medical school, the school did not exercise control over the doctor’s conduct of Engel’s surgery, which was conducted on a private patient in a private hospital, and the medical school did not pay Skoskiewicz either directly or through a university-affiliated organization for providing medical services.

In order to meet the alternative requirement for immunity that Skoskiewicz was acting as an elected or appointed  “officer” of the state, Justice Pfeifer wrote: “To be sure, the letters that Dr. Skoskiewicz received from the College of Medicine stated that the College of Medicine had approved his ‘appointment’ to the volunteer faculty at the rank of clinical assistant professor.  As support for the proposition that Dr. Skoskiewicz had been appointed to an R.C. 109.36 ‘office or position,’ however, these letters are a slender reed. We refuse to read so much into the letters’ use of the word ‘appointment’ because, to us, the more significant words in R.C. 109.36(A)(1)(a) are ‘office and position with the state.’

“In State ex rel. Newman v. Skinner (1934) ... (w)e stated that ‘[a] public officer, as distinguished from an employee, must possess some sovereign functions of government to be exercised by him for the benefit of the public either of an executive, legislative, or judicial character.’ ... Clearly, Dr. Skoskiewicz possessed no ‘sovereign’ function of an executive, legislative, or judicial character.  And his duties were not of a level consonant with those of a public office.  The appointment did not entitle Dr. Skoskiewicz to office space, staff, or authority at the College of Medicine; did not enable him to lecture or teach a class at the College of Medicine; did not allow him to conduct university-sponsored research, although he was allowed to collaborate with College of Medicine researchers; did not allow him to practice at the university clinic; and did not entitle him to payment from the College of Medicine.  In truth, based on the record before us, the appointment did not enable Dr. Skoskiewicz to do anything except, as stipulated, allow students to ‘rotate through Dr. Skoskiewicz’s practice as a part of one-month clerkships.’”

“Dr. Skoskiewicz and the many other volunteer clinical faculty in Ohio provide an important service.  But that service, however commendable, does not transform the volunteers behind it into an arm of the state.  Based on the record before us, we conclude that Dr. Skoskiewicz did not hold an appointed office or position with the state. ... Accordingly, he is not entitled to personal immunity pursuant to R.C. 9.86.”

(Mike Frisch)

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